Background:
There is minimal information available on the threshold at which patients consider themselves to be well for patient-reported outcome measures used in patients treated with hip ...arthroscopy for femoroacetabular impingement (FAI).
Purpose:
To determine the patient acceptable symptomatic state (PASS) for the modified Harris Hip Score (mHHS) and the Hip Outcome Score (HOS) in patients with FAI treated with arthroscopic hip surgery.
Study Design:
Cohort study (diagnosis); Level of evidence, 2.
Methods:
A consecutive series of patients at a single institution with FAI who were treated with arthroscopic labral surgery, acetabular rim trimming, and femoral osteochondroplasty were eligible. The mHHS (score range, 0-100) and the HOS (score range, 0-100) were administered at baseline and at 12 months postoperatively. An external anchor question at 1 year postoperatively was utilized to determine PASS values: “Taking into account all the activities you have during your daily life, your level of pain, and also your functional impairment, do you consider that your current state is satisfactory?”
Results:
There were 130 patients (mean ± SD age, 35.6 ± 11.7 years), and 42.3% were male. Based on a receiver operator curve analysis, the PASS values—at which patients considered their status to be satisfactory—at 1 year after surgery were 74 (mHHS), 87 (HOS–activities of daily living subscale), and 75 (HOS–sports subscale). The PASS threshold was not affected by baseline scores across different instruments. However, patients with higher baseline scores were more likely to achieve the PASS (odds ratios: 3.36 mHHS, 3.83 HOS–activities of daily living, 3.38 HOS-sports). Age and sex were not significantly related to the odds of achieving the PASS for the mHHS or the HOS.
Conclusion:
This is the first study to determine the PASS for 2 commonly used hip joint patient-reported outcome measures in patients undergoing surgery for FAI. The study findings can allow researchers to determine if interventions related to FAI are meaningful to patients at the individual level across various domains and will also be useful for responder analyses in future randomized trials related to hip arthroscopy and the treatment of FAI.
We developed 2 complementary low-fidelity models to be used to create the tool skills needed to perform small joint arthroscopy. The purpose of the study was to establish the face and construct ...validity of the 2 models.
The "foundation model" was constructed from lemon and radish sections, and the "advanced model" was constructed from a chicken knee. Using both models, novice, intermediate, and experienced participants were asked to perform specific tasks and were timed and scored on their performance. The experienced surgeons were given a 16-item survey to rate how closely each model emulated reality to determine face validity.
For the foundation model, the mean total time for the completion of tasks was 1,138 seconds for novices, 1,059 seconds for intermediates, and 631 seconds for experienced, with significant differences between the groups for time to complete 2 of the tasks. With a maximum possible score of 50 points for the correct performance of all tasks, the mean total performance score was 23 for novices, 31.8 for intermediates, and 42.2 for experienced operators. For the advanced model, the mean total time for completion was 266 seconds for novices, 147 seconds for intermediates, and 72 seconds for experienced participants. With a maximum possible score of 31 points for the correct performance of all tasks, the mean total performance score was 1.9 for novices, 15.0 for intermediates, and 24.3 for experienced participants. The average scores for the face validity surveys using a 5-point Likert scale were 4.2 and 4.5 of 5 possible points for the foundation and advanced models, respectively.
Experienced operators completed the tasks more quickly and had higher performance scores than the operators in other groups. This correlation between experience and performance suggests that both models have construct validity. The face validity scores were on the upper end of the scale, suggesting that both models emulate reality for experienced operators.
These novel models provide low-cost, available and valid simulations conducive to high-repetition training.
Background:
Surgical simulation has become increasingly relevant to orthopaedic surgery education and could translate to improved operating room proficiency in orthopaedic surgery trainees.
Purpose:
...To compare the arthroscopic performance of junior orthopaedic surgery residents who received training with a knee and shoulder arthroscopy surgical simulator with those who received didactic training.
Study Design:
Controlled laboratory study.
Methods:
Fourteen junior orthopaedic surgery residents at a single institution were randomized to receive knee and shoulder arthroscopy training with a surgical simulator (n = 8) or didactic lectures with arthroscopy models (n = 6). After their respective training, performance in diagnostic knee and shoulder arthroscopy was assessed using a cadaveric model. Time to completion and assessment of arthroscopic handling using a subjective injury grading index (scale, 1-10) was then used to evaluate performance in final cadaveric testing.
Results:
Orthopaedic surgery residents who trained with a surgical simulator outperformed the didactic-trained residents in shoulder arthroscopy by time to completion (–35%; P = .02) and injury grading index (–35%; P = .01). In addition, a trend toward improved performance of knee arthroscopy by the simulator-trained group was found by time to completion (–36%; P = .09) and injury grading index (P = .08).
Conclusion:
In this study, junior orthopaedic surgery residents who trained with a surgical simulator demonstrated improved arthroscopic performance in both knee and shoulder arthroscopy. However, future validation of surgical simulator training for orthopaedic surgery residents remains warranted.
Clinical Relevance:
Surgical skill development with an arthroscopy surgical simulator could translate to improved arthroscopy performance in the operating room.
Background:
Although sports participation and heavy physical work can contribute to rotator cuff tears, many patients expect to return to these activities after surgery; however, irreparable rotator ...cuff tears can preclude this outcome. A new surgical treatment—arthroscopic superior capsule reconstruction (SCR)—restores shoulder stability and muscle balance in patients with irreparable rotator cuff tears; consequently, it improves shoulder function and relieves pain.
Purpose:
To evaluate the rates of return to sports and physical work among patients treated with arthroscopic SCR.
Study Design:
Cohort study; Level of evidence, 3.
Methods:
From 2007 to 2014, we performed arthroscopic SCR in 105 patients with irreparable rotator cuff tears, 5 of whom were lost to follow-up. Consequently, 100 patients (mean age, 66.9 years; range, 43-82 years) were enrolled in the study. Before surgery, 26 patients had participated in sports (2 competitive, 24 recreational), and 34 patients had physical work. Rates of return to sports and physical work, the American Shoulder and Elbow Surgeons (ASES) score, active shoulder range of motion, and rate of graft tear were evaluated. The mean time to final follow-up was 48 months (range, 24-88 months).
Results:
All 26 patients who played sports before their injuries returned fully to them. In addition, 32 patients returned fully to their previous physical work, whereas the 2 remaining patients returned with reduced hours and workloads. As compared with the nonsports group, the sports group had significantly higher postoperative active elevation (160° ± 32° vs 146° ± 39°; P = .04) and higher postoperative ASES scores (97 ± 7 vs 91 ± 12; P = .02). The shoulder range of motion and ASES scores before and after surgery did not differ significantly between the physical and nonphysical work groups (P = .11-.99). The rate of graft tear did not differ between the sports group (4%) and nonsports group (5%) (P = .75) and between the physical work group (6%) and nonphysical work group (5%) (P = .77).
Conclusion:
Arthroscopic SCR restored shoulder function and resulted in high rates of return to recreational sports and physical work.
Background:
Previous studies on periacetabular osteotomy (PAO) reported complication and reoperation rates of 5.9% and 10%, respectively. Hip arthroscopy is increasingly utilized as an adjunct ...procedure to PAO to precisely treat associated intra-articular pathology. The addition of this procedure has the potential of further increasing complication rates.
Purpose:
To determine the rates of complication and reoperation of combined hip arthroscopy and PAO for the treatment of acetabular deformities and associated intra-articular lesions.
Study Design:
Case series; Level of evidence, 4.
Methods:
Using a prospective database, the authors retrospectively reviewed 248 hips (240 patients) that underwent combined hip arthroscopy and PAO between 2007 and 2016. Data were collected at scheduled follow-up visits at approximately 1 month, 3 to 4 months, and 1 and 2 years after surgery. Mean follow-up from surgery was 3 years (range, 1-8 years). A total of 220 PAOs were done for symptomatic acetabular dysplasia, 18 for symptomatic acetabular retroversion, and 10 for combined acetabular dysplasia and acetabular retroversion. Central compartment arthroscopy was performed for treatment of intra-articular chondrolabral pathology in all cases. Select cases underwent femoral head-neck junction osteochondroplasty either arthroscopically before the PAO or through an open approach after it. Complications were graded according to the modified Dindo-Clavien complication scheme, which was validated for hip preservation procedures. Reoperations (excluding hardware removal) were recorded.
Results:
Grade III complications occurred among 7 patients (3%) while there were no grade IV complications. Grade III complications included deep infection (n = 3), wound dehiscence (n = 1), hematoma requiring exploration (n = 1), symptomatic heterotopic ossification requiring excision (n = 1), and deep venous thrombosis (n = 1). There were 13 reoperations (5%), and 3 were repeat hip arthroscopy. Univariate Cox hazard models were used to estimate the relative risk factors for complication and reoperation. Increased age (per decade) showed over twice the increased likelihood for complications (hazard ratio, 2.5; 95% CI, 1.67-3.74). Also, preoperative diagnosis of acetabular retroversion, not acetabular dysplasia, showed >3 times the increased risk of reoperation (hazard ratio, 3.05; 95% CI, 1.41-6.61).
Conclusion:
The rate of complications reported is comparable (3%) with previously published complication rates of PAO without hip arthroscopy. In this cohort, increasing age and diagnosis of acetabular retroversion were associated with higher complication and reoperation rates.
We quantified the risk of 90-day postoperative infection following arthroscopy, stratified by specific time intervals of corticosteroid injection (CSI) postoperatively (0-2 weeks, 2-4 weeks, 4-6 ...weeks, and 6-8 weeks).
A national, all-payer database was queried. In the primary and secondary analyses, the main outcome was infection at 90-days. Infection was defined by documentation of a septic knee or surgical-site infection according to International Classification of Disease (ICD) Ninth Revision (9) and Tenth Revision (10) codes, and Current Procedure Terminology (CPT) codes.
In the multivariable regression, the odds ratio (OR) of postoperative infection at 90-days was greater in the CSI injections within 0-<2 weeks (OR 3.31, 95% CI 1.85-5.92, P<0.001) and 2-<4 weeks (OR 2.72 95% CI 1.57-4.71, P=0.003) cohorts in comparison to the control group.
When comparing CSI administered within 0-2 weeks to CSI administered within 2-4 weeks, there was a greater odds of postoperative infection (OR 2.50) at 90-days following arthroscopy.
CSI given within 2 weeks following knee arthroscopy increases the risk of postoperative infection the greatest whereas CSI given with 4 weeks increases the risk but to a lesser degree.
Purpose The learning curve for hip arthroscopy is consistently characterized as “steep.” The purpose of this systematic review was to (1) identify the various learning curves reported in the ...literature, (2) examine the evidence supporting these curves, and (3) determine whether this evidence supports an accepted number of cases needed to achieve proficiency. Methods The electronic databases Embase and Medline were screened for any clinical studies reporting learning curves in hip arthroscopy. Two reviewers conducted a full-text review of eligible studies and a hand search of conference proceedings and reference sections of the included articles. Inclusion/exclusion criteria were applied, and a quality assessment was completed for each included article. Descriptive statistics were compiled. Results We identified 6 studies with a total of 1,063 patients. Studies grouped surgical cases into “early” versus “late” in a surgeon's experience, with 30 cases being the most common cutoff used. Most of these studies used descriptive statistics and operative time and complication rates as measures of competence. Five of 6 studies showed improvement in these measures between early and late experience, but only one study proposed a bona fide curve. Conclusions This review shows that when 30 cases was used as the cutoff point to differentiate between early and late cases in a surgeon's experience, there were significant reductions in operative time and complication rates. However, there was insufficient evidence to quantify the learning curve and validate 30, or any number of cases, as the point at which the learning curve plateaus. As a result, this number should be interpreted with caution. Level of Evidence Level IV, systematic review of Level IV studies.
Purpose
To test the face validity of the hip diagnostics module of a virtual reality hip arthroscopy simulator.
Methods
A total of 25 orthopaedic surgeons, 7 faculty members and 18 orthopaedic ...residents, performed diagnostic supine hip arthroscopies of a healthy virtual reality hip joint using a 70° arthroscope. Twelve specific targets were visualised within the central compartment; six via the anterior portal, three via the anterolateral portal and three via the posterolateral portal. This task was immediately followed by a questionnaire regarding the realism and training capability of the system. This consisted of seven questions addressing the verisimilitude of the simulator and five questions addressing the training environment of the simulator. Each question consisted of a statement stem and 10-point Likert scale. Following similar work in surgical simulators, a rating of 7 or above was considered an acceptable level of realism.
Results
The diagnostic hip arthroscopy module was found to have an acceptable level of realism in all domains apart from the tactile feedback received from the soft tissue. 23 out of 25 participants (92%) felt the simulator provided a non-threatening learning environment and 22 participants (88%) stated they enjoyed using the simulator. It was most frequently agreed that the level of trainees who would benefit most from the simulator were registrars and fellows (22 participants; 88%). Additionally, 21 of the participants (84%) agreed that this would be a beneficial training modality for foundation and core trainees, and 20 participants (80%) agreed that his would be beneficial for consultants.
Conclusions
This VR hip arthroscopy simulator was demonstrated to have a sufficient level of realism, thus establishing its face validity. These results suggest this simulator has sufficient realism for use in the acquisition of basic arthroscopic skills and supports its use in orthopaedics surgical training.
Level of evidence
I.
PDF
